[e-drug] Out Patient Parenteral Therapy [cont]

["Linda Bryant" <lindab@iconz.co.nz>]

E-DRUG: Out Patient Parenteral Therapy [cont]
---------------------------------------------

While the concept of outpatient parenteral therapy is good, as mentioned in
previous emails it depends on the healthcare system. In NZ in the area I
work
in, our general practitioners (primary care physicians) can treat cellulitis
by home IV therapy but:

1. The patient visits the general practitioner for their daily IV therapy.
This visit is paid for by the public healthcare system, as is the medicine.
Among other things this is a safety issue (hygiene etc), and a cost issue as
home visits are expensive

2. The treatment is only used in order to avoid a more costly hospital
admission (ie the patient would have been admitted otherwise and this is
checked by a clinical board review)

3. We have grave concerns about antibiotic resistance and so we use a FIRST
generation cephalosporin, plus prebencid (evidence available for this
therapy
from RCTs). This is a major issue for us and we would not have proceded if
it
had meant using a third generation cephalosporin (general practitioners can
not usually prescribe third generation cephalosporins in NZ for community
use.
They are limited to hospital care) We should not put convenience above the
issues of the risk of resistance in the community

4. The treatment is limited to 3 days and then the person is transferred to
oral therapy, or admitted to hospital if therapy has not been adequate.

5. There are guidelines to follow re: baseline investigations because of the
risk of MRSA etc.

This is a different perspective to OPAT originating from a hospital but
issues
re: safety and antibiotiuc resistance should be a concern in all situations.

The system is not simple and there needs to be a lot of checks and balances,
with a strong workforce in the community, and selected patients who will be
responsible for their care at home and have adequate support in case of any
complications.

Cheers,

Linda Bryant
Pharmacist Facilitator
Auckland, New Zealand
Email: lindab@iconz.co.nz
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